Anesthetic morbidity associated with the induction of general anesthesia and developing during local anesthetic procedures relates both to errors of omission by the anesthetic team and to hastily committed mistakes.
When an anesthesiologist is performing his function during a medical procedure in an operating room and is administering anesthetic to a patient and then monitoring the patient's vital signs, it is customary for him or her to be positioned at the head end of the operating table adjacent the head of the patient. Various instruments, including endotracheal tubes, laryngoscopes, syringes and airways are required from time to time by the anesthesiologist, the syringes containing various chemicals and medications, and these are commonly placed on a cart or table to the right or left of the anesthesiologist, within reach, preferably in a neat and orderly array so that the article needed can be obtained quickly.
Speed can be a very important factor during surgery, and particularly the quickness with which the anesthesiologist can obtain the needed instrument or medication because he or she is usually without assistance and must continuously engage in life support activity. It is not unusual, for example, for the anesthesiologist to be manually operating a ventilator which "breathes" for the patient because certain anesthetic drugs temporarily impair or eliminate the patient's ability to breathe for himself while under the influence of the drug. This ventilating action must not only be continued at a steady rate but that rate must be adjusted, depending on the progress of the surgery and the patient's condition.
Clearly, this requires the anesthesiologist's full attention and it is quite a serious disadvantage for him to need to look away from the patient and reach for what he needs, especially when the need for an instrument or medication is most likely to arise because of an adverse change in the patient's condition, a time when the full and undivided attention of the anesthesiologist can be most critically needed.
Past published anesthetic history is replete with patient catastrophes occurring as a result of anesthetic misadventures during the induction and eduction of anesthesia. These misadventures usually result from problems related to the airway (i.e., upper airway obstruction due to lingual and paraglottic tissue relaxation, laryngospasm, esophageal intubation, tracheal aspiration of gastric contents, etc.).
The errors of omission are preventable and include:
1. Failure to assure a functional suction (vacuum) source close to the patient and anesthetist.
2. Lack of a "backup" laryngoscope blade.
3. Forgotten upper airway devices such as nasal and oral airways of appropriate sizes.
4. Misplacement of endotracheal tubes and lack of backup tubes with attached inflation syringes.
5. Forgotten blood pressure manometers.
6. Misplacement of aligned and labeled anesthetic drugs.
7. Proper head and neck positioning for tracheal intubation.
This problem has been recognized in practice and some anesthesiologists have resorted to makeshift solutions such as placing selected instruments on the surgical drape over the patient's chest or on the table areas which may be unoccupied. These solutions are, however, not regarded as being satisfactory because those areas are not necessarily sterile and because of the probability that a tool will fall from one of these irregular or smooth surfaces to the floor, requiring that a replacement be obtained, and also because it is very difficult to have any organization to the arrangement in the rather limited and miscellaneous spaces used.
Anyone familiar with the operating room setting can remember at least one incident where anesthetic misadventures on induction were followed by a flurry of opening drawers, scattering of nonfunctional laryngoscope blades, and searching for suction adaptors, airways and drugs. The tragic descriptive triad "vomited, aspirated and died" speaks for itself and is followed by increased awareness for a short period of time but all too soon is forgotten in the rapidly moving, complex and sometimes monotonous daily world of the operatory.
similar problems along with some rather different and more general problems associated with storage, shipping and use of medical tools and medications, have been considered by prior art workers, the results being seen in various U.S. patents of which the following are examples.
U.S. Pat. No. 3,013,656; Murphy, Jr.
U.S. Pat. No. 3,650,393; Reiss et al
U.S. Pat. No. 3,696,920; Lahay
U.S. Pat. No. 3,776,387; Brent
U.S. Pat. No. 3,802,555; Grasty et al
U.S. Pat. No. 4,085,845; Perfect
U.S. Pat. No. 4,149,635; Stevens
U.S. Pat. No. 4,160,505; Rauschenberger
A similar problem is treated by Brent, but the solution presented is not a fully satisfactory one because of some elements of risk involved and because the Brent device is useful in holding only those articles having a major portion made of a ferrous material.